Form B-09 - Application For Certificate Of Authority
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3State of North Carolina
Department of the Secretary of State
APPLICATION FOR CERTIFICATE OF AUTHORITY
Pursuant to §55-15-03 of the General Statutes of North Carolina, the undersigned corporation hereby applies for a Certificate of
Authority to transact business in the State of North Carolina, and for that purpose submits the following:
1. The name of the corporation is _________________________________________________ ; and if the corporate name is
unavailable for use in the State of North Carolina, the name the corporation wishes to use is:
_________________________________________________________________________________________________.
2. The state or country under whose laws the corporation was organized is: ________________________________________.
3. The date of incorporation was ______________ ; its period of duration is: ______________________________________.
4. Principal office information: (Select either a or b.)
a.
The corporation has a principal office.
The street address and county of the principal office of the corporation is:
Number and Street_____________________________________________________________________________
City, State, Zip Code___________________________________________County___________________________
The mailing address, if different from the street address, of the principal office of the corporation is:
____________________________________________________________________________________________
b.
The corporation does not have a principal office.
5. The street address and county of the registered office in the State of North Carolina is:
Number and Street _________________________________________________________________________________
City, State, Zip Code _________________________________________County________________________________
6. The mailing address, if different from the street address, of the registered office in the State of North Carolina is:
________________________________________________________________________________________________
7. The name of the registered agent in the State of North Carolina is: ___________________________________________
8. The names, titles, and usual business addresses of the current officers of the corporation are (attach if necessary):
Name
Title
Business Address
9. Attached is a Certificate of Existence (or document of similar import) duly authenticated by the Secretary of State or other
The Certificate of Existence must be
official having custody of corporate records in the state or country of incorporation.
an original and less than six months old.
CORPORATIONS DIVISION
P. O. BOX 29622
RALEIGH, NC 27626-0622
(Revised January, 2002)
(Form B-09)
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